CAN I AVOID A MAXILLARY SINUS LIFT?
Dear Dr A,
I guess you are another fictitious Doc with an alphabet. Nevertheless, it is an interesting question.
If you do not want to do a sinus lift, any reason will do though it might not be a good one. I myself once did not want to do it because I hated having to make a large opening into the sinus! And if I can avoid it, I did. So I tried crestal lifts invented by Summers. Works, but often found myself having to spend more time than if I just did a lateral window which is more sure and definitive. There are various ingenious ways nowadays, the latest seem to be the “hatch” technique with a special off centre drill.
However, if you want to avoid all these, there are several ways to avoid a sinus lift altogether:-
* Do a conventional bridge on adjacent teeth. Use the tooth in front and the tooth behind the edentulous space. Or a cantilever might work.
* Place an implant in the tuberosity where there is usually more than enough bone and join it to the natural tooth just anterior to the edentulous space.
* Or use MINIs! Do a tripod. 3 minis with the tips cut off at 5mm length, and build a crown on it.
* 2 or 3 Minis carefully threaded into the walls of the sinus on the buccal and the palatal where there is usually 3-5mm thickness of bone. These technique requires a lot of skill and experience though.
* Use short large diameter fixtures from Bicon, Endopore or some of these Korean makers that come in diameters up to 8mm!
* Or like Dr Richard Hughes suggest…. place in a subperiosteal.
* Do a conventional bridge on adjacent teeth. Use the tooth in front and the tooth behind the edentulous space. Or a cantilever might work.
* Place an implant in the tuberosity where there is usually more than enough bone and join it to the natural tooth just anterior to the edentulous space.
* Or use MINIs! Do a tripod. 3 minis with the tips cut off at 5mm length, and build a crown on it.
* 2 or 3 Minis carefully threaded into the walls of the sinus on the buccal and the palatal where there is usually 3-5mm thickness of bone. These technique requires a lot of skill and experience though.
* Use short large diameter fixtures from Bicon, Endopore or some of these Korean makers that come in diameters up to 8mm!
* Or like Dr Richard Hughes suggest…. place in a subperiosteal.
Now all of the above require quite a lot of skill and experience…..maybe you might just want to learn to do a lateral window sinus lift which actually, once you get the hang of it may be actually simpler and surer in results!
Cheers.
Dr Chow – Three questions. 1} Never thought of “cutting off the tips” at 5mm on a mini. How do you do that? 2.}How do you get it to “catch” the threads if the tip is cut off? 3.}I have built several crowns on tripod minis, but I haven’t seen clinical techniques discussed on how to “fix” the parallel problem. Your suggestions?
Hi Ken,
Since we have only 5mm bone height, we can reduce the threaded part of the mini-implant to 5mm by cutting of 5mm of a 10mm thread. Use a sterile orthodontic cutter. Grip the mini by the collar with a sterile orthodontic pliers or even a tweezer…. and then cut! With experience, you can just cut off 3mm and leave a 7mm threaded part. As you screw it in, it will do a Summers sinus lift.
Always make sure your drill hole is about 0.8 to 1.0 mm in diameter smaller than your mini diameter. If you are using a 2.5mm diameter mini, your last drill should be 1.5mm diameter or even less if your bone is soft. If the drill hole diameter is smaller than your implant diameter, then even if you have cut off the tip, the remaining threads should still bite into the side of the hole and draw in the implant as you clockwise it.
Lastly, you have rightly observed that our current prosthodontic solutions for the minis for both removable and fixed prostheses are still less than satisfactory in terms of simplicity and ease of maintenance. As such, I have developed a system called “THE BUDDY SYSTEM” to try to address the current shortcomings. I will post the sequential write-up in my smalldentalimplants.blogspot.com and will appreciate yours and others advice for any possible improvement. Hopefully, the problem of parallelism can be resolved with a moulding device and that of maintenance of fixed prostheses can be resolved with the use of “cleaning grooves” which I will describe.
Warmest regards and cheers.
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